State Fiscal Considerations and Research Opportunities Emerging from the Affordable Care Act's Medicaid Expansion

2014 ◽  
Vol 40 (2-3) ◽  
pp. 237-252
Author(s):  
Jean C. Sullivan ◽  
Rachel Gershon
Keyword(s):  
Low Income ◽  
Insurance Coverage ◽  
Supreme Court Decision ◽  
Health Insurance Coverage ◽  
The United States ◽  
Primary Objective ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Assistance Program ◽  
Social Security Act

As enacted, the Affordable Care Act (ACA) directed states to provide Medicaid coverage to most nonelderly adults with incomes up to 138% of the Federal Poverty Level (the “Medicaid expansion group”) beginning in 2014. The Medicaid expansion provision of the ACA is an integral component of fulfilling the ACA’s primary objective to achieve near-universal health insurance coverage rates across the United States.Title XIX of the Social Security Act (Title XIX) is Medicaid’s enabling statute. Medicaid is a medical assistance program for certain low-income individuals, jointly funded and administered by federal and state governments. Certain features of the Medicaid program provide a framework within which the ACA and subsequent Supreme Court decision National Federation of Independent Business (NFIB) v. Sebelius can be understood.

Effects of Medicaid Expansion on Poverty Disparities in Health Insurance Coverage

2021 ◽  
Author(s):  
Yilu Lin ◽  
Alisha Monnette ◽  
Lizheng Shi
Keyword(s):  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Community Survey ◽  
Medicaid Expansion ◽  
Market Exchange ◽  
Federal Poverty Level ◽  
Poverty Level ◽  
The Impact ◽  
Poverty Levels

Abstract Background: More than 30 States have either expanded Medicaid or considering expansion. The coverage gains from this policy is well documented, however, the impacts of its increasing coverage on poverty disparity are unclear at national level.Method: American Community Survey (2012-2018) was used to examine the effects of Medicaid expansion (ME) on poverty disparity in insurance coverage for nonelderly adults in the United States. Differences-in-differences-in-differences design was used to analyze the trends in uninsured rates (UR) by different poverty levels: <138%, 138–400% and >400% federal poverty level (FPL).Results: Compared with UR in 2012, UR in 2018 decreased by 10.75%, 6.42%, and 1.11% for <138%, 138-400%, and >400% FPL. From 2012-2018, >400% FPL group continuously had the lowest UR and <138% FPL group had the highest UR. Compared with ≥ 138% FPL groups, there was a 2.54% reduction in uninsured risk after ME among <138% FPL group in ME states versus control states. After eliminating the impact of the ACA market exchange premium subsidy, 3.18% decrease was estimated. Conclusion: Poverty disparity in UR improved with ME. However, <138% FPL population are still at a higher risk for being uninsured.

scholarly journals Effects of medicaid expansion on poverty disparities in health insurance coverage

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yilu Lin ◽  
Alisha Monnette ◽  
Lizheng Shi
Keyword(s):  
Insurance Coverage ◽  
National Level ◽  
Health Insurance Coverage ◽  
The United States ◽  
Medicaid Expansion ◽  
Market Exchange ◽  
Federal Poverty Level ◽  
Poverty Level ◽  
The Impact ◽  
Poverty Levels

Abstract Background More than 30 states have either expanded Medicaid or are actively considering expansion. The coverage gains from this policy are well documented, however, the impacts of its increasing coverage on poverty disparity are unclear at the national level. Method American Community Survey (2012–2018) was used to examine the effects of Medicaid expansion on poverty disparity in insurance coverage for nonelderly adults in the United States. Differences-in-differences-in-differences design was used to analyze trends in uninsured rates by poverty levels: (1) < 138 %, (2) 138–400 % and (3) > 400 % federal poverty level (FPL). Results Compared with uninsured rates in 2012, uninsured rates in 2018 decreased by 10.75 %, 6.42 %, and 1.11 % for < 138 %, 138–400 %, and > 400 % FPL, respectively. From 2012 to 2018, > 400 % FPL group continuously had the lowest uninsured rate and < 138 % FPL group had the highest uninsured rate. Compared with ≥ 138 % FPL groups, there was a 2.54 % reduction in uninsured risk after Medicaid expansion among < 138 % FPL group in Medicaid expansion states versus control states. After eliminating the impact of the ACA market exchange premium subsidy, 3.18 % decrease was estimated. Conclusion Poverty disparity in uninsured rates improved with Medicaid expansion. However, < 138 % FPL population are still at a higher risk for being uninsured.

scholarly journals The convergence of racial and income disparities in health insurance coverage in the United States

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
De-Chih Lee ◽  
Hailun Liang ◽  
Leiyu Shi
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Combined Effect ◽  
Medical Expenditure ◽  
The Us ◽  
Race Ethnicity ◽  
Vulnerability Measure

Abstract Objective This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. Data source The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. Study design Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. Data collection/extraction methods We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findings While income was a significant predictor of health insurance coverage (a difference of 6.1–7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. Conclusion Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.

Insurance coverage and care affordability in cancer survivors in 2016-2019.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1520-1520
Author(s):  
Justin Michael Barnes ◽  
Eric Adjei Boakye ◽  
Mario Schootman ◽  
Evan Michael Graboyes ◽  
Nosayaba Osazuwa-Peters
Keyword(s):  
United States ◽  
Cancer Survivors ◽  
Low Socioeconomic Status ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The United States ◽  
Mediating Effect ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Linear Probability

1520 Background: The Affordable Care Act (ACA) led to improvements in insurance coverage and care affordability in cancer patients. However, the uninsured rate for the general US reached its nadir in 2016 and has been increasing since. We aimed to quantify the changes in insurance coverage and rate of care unaffordability in cancer survivors from 2016 to 2019. Methods: We queried data from the Behavioral Risk Factor Surveillance System (2016-2019) for cancer survivors ages 18-64 years. Outcomes of interest were the percentage of cancer survivors reporting insurance coverage and the percentage reporting cost-driven lack of care in the previous 12 months. Survey-weighted linear probability models adjusted for covariates (age, sex, race/ethnicity, income, education, marital status, and state Medicaid expansion status) were utilized to estimate the average yearly change (AYC) in the outcomes across 2016-2019. Mediation analyses evaluated the mediating effect of insurance coverage changes on changes in cost-driven lack of care. Results: A total of 178,931 cancer survivors were identified among the survey respondents. The percentage of insured cancer survivors between 2016 and 2019 decreased from 92.4% to 90.4% (AYC: -0.54, 95% CI = -1.03 to -0.06, P =.026). This translates to an estimated 164,638 cancer survivors in the United States who lost insurance coverage in the study period. There were decreases in private insurance coverage (AYC: -1.66, 95% CI = -3.1 to -0.22, P =.024) but increases in Medicaid coverage (AYC: 1.14, 95% CI = 0.03 to 2.25, P =.043). The decreases in any coverage were largest in individuals with income < 138% federal poverty level (FPL) (AYC: -1.14, 95% CI = -2.32 to 0.04, P =.059; compared to > 250% FPL, Pinteraction=.03). Cost-driven lack of care in the preceding 12 months among cancer survivors increased from 17.9% in 2016 to 20% in 2019 (AYC: 0.67, 95% CI = 0.06 to 1.27, P =.03), which translates to an estimated 167,184 survivors in the US who skipped care due to costs. Changes in insurance coverage mediated 27.5% of the observed change in care unaffordability overall (p =.028) and 65.7% in individuals with income < 138% FPL relative to > 250% FPL (p =.045). Conclusions: Between 2016 and 2019, about 165,000 cancer survivors in the United States lost their insurance coverage and a similar number may have skipped needed care due to cost. Loss of insurance coverage was mostly among individuals with low socioeconomic status. Interventions to improve health insurance coverage among cancer survivors, such as the recent executive order to strengthen the ACA and further efforts promoting Medicaid expansion in additional states, may be important factors to mitigate these trends.

scholarly journals A National Survey of Trends in Health Insurance Coverage of Low-Income Adults Following Medicaid Expansion

2019 ◽  
Vol 35 (6) ◽  
pp. 1911-1913 ◽  
Author(s):  
Mark Olfson ◽  
Melanie M. Wall ◽  
Colleen L. Barry ◽  
Christine Mauro ◽  
Tianshu Feng ◽  
...  
Keyword(s):  
Health Insurance ◽  
National Survey ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Medicaid Expansion

scholarly journals The Convergence of Racial and Income Disparities in Health Insurance Coverage in the United States

2020 ◽  
Author(s):  
De-Chih Lee ◽  
Hailun Liang ◽  
Leiyu Shi
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Combined Effect ◽  
Medical Expenditure ◽  
The Us ◽  
Race Ethnicity ◽  
Vulnerability Measure

Abstract ObjectiveThis study applies the vulnerability framework and examines the combined effect of race and income on health insurance coverage in the US. Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage.Data sourcesThe household component of the US Medical Expenditure Panel Survey (MEPS-HC) in 2017 was used for the study.Study designLogistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or partially insured, partially insured only, and uninsured only, respectively.Data collection/extraction methodsWe constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findingsWhile income was a significant predictor of health insurance coverage (a difference of 6.1%-7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 66% less odds of being insured instead of uninsured or partially insured than high-income Whites with good health.ConclusionsPolicymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and are racial/ethnic minorities.

Male Retirement Behavior in the United States, 1930–1950

1991 ◽  
Vol 51 (3) ◽  
pp. 657-674 ◽  
Author(s):  
Donald O. Parsons
Keyword(s):  
Social Security ◽  
Old Age ◽  
Low Income ◽  
The United States ◽  
Private Pension ◽  
Assistance Program ◽  
The Social ◽  
Retirement Behavior ◽  
Old Age Assistance ◽  
Social Security Act

Explanations for the recent decline in the labor force attachment of males 65 years of age and older include the introduction of Old Age and Survivors Insurance and the growth in private pension programs. Neither hypothesis can explain the sizable decline that occurred between 1930 and 1950, when aggregate social security and private pension payments were small. Estimates from pooled state aggregate data indicate that the means-tested Old Age Assistance program established by the Social Security Act of 1935 significantly increased retirement activity in this period, particularly among low-income individuals.

scholarly journals Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

2020 ◽  
Vol 112 (7) ◽  
pp. 671-687 ◽  
Author(s):  
K Robin Yabroff ◽  
Katherine Reeder-Hayes ◽  
Jingxuan Zhao ◽  
Michael T Halpern ◽  
Ana Maria Lopez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Insurance ◽  
Low Income ◽  
Cancer Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Stage At Diagnosis ◽  
Data Infrastructure ◽  
Study Characteristics

Abstract Background Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival. Methods We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively. Results Studies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions. Conclusions Health insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes.

A Health Insurance Tax Credit for Uninsured Workers

2001 ◽  
Vol 38 (2) ◽  
pp. 106-120 ◽  
Author(s):  
Lawrence Zelenak
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Tax Credits ◽  
Tax Credit ◽  
Poverty Level ◽  
The Cost ◽  
Insurance Tax ◽  
Age And Sex

This paper describes a new system of tax credits to help low-income workers pay for health insurance. The system would be designed to subsidize health insurance coverage for workers who are currently uninsured, or who pay high premiums for nongroup insurance. Anyone age 19 or older who is not covered by Medicaid, Medicare, or employer-sponsored health insurance would be eligible for a health insurance tax credit (HITC), administered through the Internal Revenue Service. The base amount of the proposed credit would be $2,000 per year for each covered individual, but this amount would be adjusted for the individual's age and sex, according to the effect of age and sex on the cost of insurance coverage. The base amount of the credit would be reduced by $150 for every $1,000 by which a person's income exceeded 200% of the federal poverty level, thus limiting HITC eligibility to lower-income workers. To encourage participation in the credit program, most of the credit would be available through an advance payment system, with final reconciliation after year's end.

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